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UNITED NATIONS NATIONS Information Service
INCB ANNUAL REPORT 1995
28 February 1996
In conjunction with the release of its 1996 and 1997 annual reports, the UN's
International Narcotics Control Board issued warnings about the dramatically
increasing use of methylphenidate, primarily in the United States.
Methylphenidate is a central nervous system stimulant, whose pharmacological
properties are essentially the same as those of the widely abused amphetamines.
In the 1960s, these substances were increasingly abused and national and
international controls were strengthened accordingly. However, some of the
substances continue to be manufactured illicitly under such names as 'ice' and
'speed'.
Methylphenidate was classified under the 1971 Convention on Psychotropic
Substances in Schedule II, as having 'high abuse potential'. Subsequently, its
manufacture, consumption and abuse decreased considerably until the beginning
of the 1990s.
However, the International Narcotics Control Board (INCB) has observed that
world-wide use of methylphenidate has risen from less than 3 tonnes in 1990 to
more than 8.5 tonnes in 1994, and continued to rise in 1995. The United States
accounts for approximately 90 per cent of total world manufacture and
consumption of the substance. The unprecedented sharp increase is due to its
controversially extensive use in the treatment of 'attention deficit disorder
(ADD)' in children. Some other countries have also reported more moderate
increases in the use of methylphenidate for this purpose.
ADD is a term used to describe a syndrome largely manifested in behavioral
patterns. The primary signs of ADD are inattention, impulsivity and, in some
cases, hyperactivity. Patients are generally boys between the ages of 6 and 14.
The combination of symptoms varies from patient to patient, and concerns have
been raised that some doctors prescribing methylphenidate are opting for an
'easy' solution for behavioral problems which may have complex causes.
The INCB shares the concern of the United States Drug Enforcement Agency (DEA)
about the increased use of methylphenidate, most commonly marketed in that
country under the brand name Ritalin. The latest data indicates that 10 to 12
per cent of all boys between the ages 6 and 14 in the United States have been
diagnosed as having ADD and are being treated with methylphenidate. Treatment
is more prevalent in middle class communities and is expected to rise in 1996.
Among the dangers, as the Board sees it, are that ADD might be diagnosed too
often overlooking other causes for attention and behavior problems and that
doctors may be overprescribing methylphenidate. United States investigators
found divergent prescribing practices among physicians, only 1 per cent of whom
were responsible for the majority of all methylphenidate prescriptions issued.
This also has impact on regional variations in the use of methylphenidate.
The Board is also concerned that, contrary to labeling, some doctors prescribe
stimulants to children under the age of six and, in many cases, other
recommended forms of treatment are not applied. The duration of treatment with
methylphenidate, which in many countries is restricted to three years, tends to
be much longer in the United States and many children remain on it into
adolescence and even adulthood. No information on possible side-effects of such
long-term treatment with methylphenidate is currently available.
Abuse of methylphenidate in the United States has increased, with serious
damage to health, and a black market in the drug has recently emerged. The
substance is abused mainly by adolescents who purchase tablets from children
under treatment for ADD or steal them from school medical wards. A preferred
method of abuse is to crush the tablets and snort the powder. Since the drug is
touted as "accepted medication" for children, abusers are unaware of its health
hazards, which include addiction and a range of stimulant-abuse symptoms.
The INCB is also concerned that the use of Ritalin is being actively promoted
by an influential parent association, which has received significant financial
contributions from the preparation's leading United States manufacturer. The
same parent association has petitioned the DEA to ease the control of this
substance, a move which would make methylphenidate even more easily available.
Among the changes sought is dropping the requirement that the patient be
re-examined by a doctor before a prescription for methylphenidate can be
refilled.
At present, the unprecedented high level of ADD diagnosis in children, the very
widespread prescription of Ritalin and the growing abuse and black market
appear to be limited to the United States. But, the INCB foresees the
likelihood that this trend will soon take hold in other countries. Some of the
parent groups promoting methylphenidate in the United States have announced
their intention to extend their activities outside the country. The Board is
therefore requesting all Governments to exercise utmost vigilance to prevent
the overdiagnosing of ADD and any medically-unjustified treatment with
methylphenidate and other stimulants. It has also requested the World Health
Organization (WHO) to investigate this matter and to provide expertise to
national public health authorities.
UNITED NATIONS NATIONS Information Service
INCB ANNUAL REPORT 1996
4 March 1997
With abuse of illegal amphetamine-type stimulants reaching epidemic
proportions, the International Narcotics Control Board (INCB) is concerned that
despite the warning it issued a year ago, the issue still requires serious
attention.
Methylphenidate, a central nervous system stimulant with properties similar to
those of the widely-abused amphetamines, has been increasingly used to treat
attention deficit disorder (ADD) in children. Global licit consumption of the
substance -- marketed mainly as 'Ritalin'-- rose from less than three metric
tons in 1990 to more than 10 tonnes in 1995. About 90 per cent of global
consumption is in the United States. Canada consumes per capita about one half
the United States amount, and the quantities dispensed in Australia,
Switzerland and other countries are also rising but from significantly lower
levels.
Although proposals to weaken domestic control of methylphenidate were withdrawn
in the United States following the alarm raised last year by the Board and
others, consumption of the substance is still rising steeply to an estimated
10.5 tonnes in 1996 and a projected 13 tonnes in 1997. Reports indicate that in
some schools in the United States a very high percentage of students receive
stimulant medication, primarily methylphenidate. Particularly worrying is the
fact that abuse of this substance is not restricted to adolescents and adults;
the number of pre-adolescents abusing the drug is expanding. According to the
United States Drug Abuse Warning Network (DAWN), the estimated number of
methylphenidate-related emergency room cases for 10- to 14-year-olds has
multiplied tenfold since 1990 and, in 1995, reached the level of
cocaine-related emergencies for the same age-group.
In drawing attention to the methylphenidate problem in its Report of a year
ago, the Board raised the issues of possible overdiagnosing of ADD,
questionable promotional practices for methylphenidate, and the diversion of
the substance from licit channels and an increase in its abuse. The therapeutic
use of methylphenidate is now under scrutiny by the American medical community;
the INCB welcomes this .
Methylphenidate, due to its high abuse potential, was one of the first
substances to be placed under international control in Schedule II of the 1971
Convention on Psychotropic Substances.
The primary signs of ADD are inattention, impulsivity and, in some cases,
hyperactivity. Those diagnosed are generally boys between the ages of 6 and 14.
However, concerns have been raised that doctors are resorting to
methylphenidate as an "easy" solution for behavioural problems which may have
complex causes. Critics warn that parents' and teachers' assessments of what
constitutes "inattention" and "impulsivity" are highly subjective and that
doctors' prescribing practices for methylphenidate are far from uniform. A
black market in the drug has emerged in recent years, with adolescents and even
adults buying tablets from children under treatment or tablets stolen from
school medical wards, in addition to the diversion of methylphenidate from
pharmacies by theft or forged prescriptions. The preferred method of abuse is
to crush the tablets and snort the powder. Since the drug is touted as
"accepted medication" for children, abusers are unaware of its health hazards,
which include addiction and a range of stimulant-abuse symptoms.
In its current report, the Board reiterates its request to all Governments to
exercise the utmost care to prevent overdiagnosing of ADD in children and
medically unjustified treatment.